International Registration Plan Original Applicaton Schedule A

International Registration PlanOriginal ApplicationSchedule AIRP SCHEDULE AREVISED5-2012Jurisdictional UseInternational Registration Plan Weight Schedule (List the gross weight, in pounds, for which the vehicles are to be registered.)The undersigned, under oath, swears under penalty of perjury that theinformation furnished in this application and supporting documents is trueand correct and also, that he/she will comply with the mandatory recordsretention as outlined in OCC Rule 165:30-19-8.SignatureTitleDateNumber of Trailers License YearFleet NumberAccount NumberPerson to Contact Regarding ApplicationPage ofRegistrant’s Phone NumberFEIN or SSN or TINUSDOT NumberMailing Street AddressCityStateZipName of Registrant (Print or Type)Business Address(Must Indicate Address in Base Jurisdiction)CityStateZipALKYNYWVAZLANCWIARMEWYCAMDOHABCOCTDEMAORBCMIPAMBMNRINBDCFLGAMSSCNFMOSDNSMTTNONIDNETXPEILNVUTSKINNHVTPQIANJVAKSNMWANLicense Month1234569121314BCurrentLicensePlateEquip.No.YEARVehicleIdentificationNumberTYPEOklahoma Declared Combined Gross WeightTitleNumberDate of PurchasePurchasePriceAXLESSEATS7FUEL8Unladen Weight1014AFactoryPrice11Enter the USDOT of the carrier responsible for safety of the above VIN, if different than Registrant’sIs this expected to change during the year?YesNoTIN assigned to this USDOTEnter the USDOT of the carrier responsible for safety of the above VIN, if different than Registrant’sIs this expected to change during the year?YesNoTIN assigned to this USDOTEnter the USDOT of the carrier responsible for safety of the above VIN, if different than Registrant’sIs this expected to change during the year?YesNoTIN assigned to this USDOTEnter the USDOT of the carrier responsible for safety of the above VIN, if different than Registrant’sIs this expected to change during the year?YesNoTIN assigned to this USDOTEnter the USDOT of the carrier responsible for safety of the above VIN, if different than Registrant’sIs this expected to change during the year?YesNoTIN assigned to this USDOTEnter the USDOT of the carrier responsible for safety of the above VIN, if different than Registrant’sIs this expected to change during the year?YesNoTIN assigned to this USDOTEnter the USDOT of the carrier responsible for safety of the above VIN, if different than Registrant’sIs this expected to change during the year?YesNoTIN assigned to this USDOTNumber of Power Units Enter the USDOT of the carrier responsible for safety of the above VIN, if different than Registrant’sIs this expected to change during the year?YesNoTIN assigned to this USDOTMAKEName of OwnerTotal Combined Axles:Phone NumberVehicle Type:TT – Truck TractorTR – TractorTK – Truck (single)RT – Road TractorST – Semi TrailerFT – Full TrailerBS – BusCG – Converter GearFuel:D – DieselG – GasP – PropaneType of Carrier:( ) Common Exempt Commodities( ) Rental ( ) Haul for Hire( ) Private ( ) Household goods or Carnival

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International Registration PlanOriginal ApplicationSchedule AIRP SCHEDULE AREVISED5-2012Jurisdictional UseInternational Registration Plan Weight Schedule (List the gross weight, in pounds, for which the vehicles are to be registered.)The undersigned, under oath, swears under penalty of perjury that theinformation furnished in this application and supporting documents is trueand correct and also, that he/she will comply with the mandatory recordsretention as outlined in OCC Rule 165:30-19-8.SignatureTitleDateNumber of Trailers License YearFleet NumberAccount NumberPerson to Contact Regarding ApplicationPage ofRegistrant’s Phone NumberFEIN or SSN or TINUSDOT NumberMailing Street AddressCityStateZipName of Registrant (Print or Type)Business Address(Must Indicate Address in Base Jurisdiction)CityStateZipALKYNYWVAZLANCWIARMEWYCAMDOHABCOCTDEMAORBCMIPAMBMNRINBDCFLGAMSSCNFMOSDNSMTTNONIDNETXPEILNVUTSKINNHVTPQIANJVAKSNMWANLicense Month1234569121314BCurrentLicensePlateEquip.No.YEARVehicleIdentificationNumberTYPEOklahoma Declared Combined Gross WeightTitleNumberDate of PurchasePurchasePriceAXLESSEATS7FUEL8Unladen Weight1014AFactoryPrice11Enter the USDOT of the carrier responsible for safety of the above VIN, if different than Registrant’sIs this expected to change during the year?YesNoTIN assigned to this USDOTEnter the USDOT of the carrier responsible for safety of the above VIN, if different than Registrant’sIs this expected to change during the year?YesNoTIN assigned to this USDOTEnter the USDOT of the carrier responsible for safety of the above VIN, if different than Registrant’sIs this expected to change during the year?YesNoTIN assigned to this USDOTEnter the USDOT of the carrier responsible for safety of the above VIN, if different than Registrant’sIs this expected to change during the year?YesNoTIN assigned to this USDOTEnter the USDOT of the carrier responsible for safety of the above VIN, if different than Registrant’sIs this expected to change during the year?YesNoTIN assigned to this USDOTEnter the USDOT of the carrier responsible for safety of the above VIN, if different than Registrant’sIs this expected to change during the year?YesNoTIN assigned to this USDOTEnter the USDOT of the carrier responsible for safety of the above VIN, if different than Registrant’sIs this expected to change during the year?YesNoTIN assigned to this USDOTNumber of Power Units Enter the USDOT of the carrier responsible for safety of the above VIN, if different than Registrant’sIs this expected to change during the year?YesNoTIN assigned to this USDOTMAKEName of OwnerTotal Combined Axles:Phone NumberVehicle Type:TT – Truck TractorTR – TractorTK – Truck (single)RT – Road TractorST – Semi TrailerFT – Full TrailerBS – BusCG – Converter GearFuel:D – DieselG – GasP – PropaneType of Carrier:( ) Common Exempt Commodities( ) Rental ( ) Haul for Hire( ) Private ( ) Household goods or Carnival